What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case study

Chang, Ernest S.; Raja, Pushpa; Stockdale, Susan; Katz, Marian L.; Zulman, Donna M.; Eng, Jessica A.; Hedrick, Kathy H.; Jackson, Jeffrey L.; Pathak, Neha; Watts, Brook; Patton, Carrie; Schectman, Gordon; Asch, Steven M.

doi:10.1016/j.hjdsi.2017.10.001

Cited by 21 publications

(21 citation statements)

References 29 publications

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“…29 While care coordinators are commonly integrated into VA primary care, their responsibilities tend to focus on coordinating care within VA rather than communicating with community providers. 30,31 Establishing designated care coordinators focused on supporting multi-system coordination could improve coordination for Veterans who receive care in the community.…”

Section: Discussionmentioning

confidence: 99%

VA Provider Perspectives on Coordinating COPD Care Across Health Systems

et al. 2019

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BACKGROUND: More and more Veterans are receiving care from community providers, increasing the need for effective coordination across health systems. For Veterans with chronic obstructive pulmonary disease (COPD), this need is intensified by complex comorbidity patterns that often include multiple providers co-managing patient care. OBJECTIVES: We sought to understand how VA providers perceive coordination with community providers for Veterans with COPD. DESIGN: Qualitative study of VA providers. METHODS: We selected six geographically diverse VA sites and conducted semi-structured telephone interviews with providers practicing in inpatient and/or outpatient settings who care for Veterans with COPD. MAIN MEASURES: Interviews focused on communication with community providers about discharge information and clinic management. We analyzed responses according to the principles of conventional content analysis, allowing inductive themes to emerge. KEY RESULTS: We interviewed 25 providers during the period of June to October 2017. Qualitative data analysis yielded five themes: (1) VA providers perceive communication challenges between VA and community providers, including difficult, inadequate, and delayed communication; (2) communication is facilitated by personal relationships across health systems; (3) the lack of electronic health record (EHR) interoperability impairs communication, resulting in transmission of unstructured data; (4) poor communication leads to duplicative efforts and wasted resources; and (5) providers frequently rely on patients to communicate about care taking place in the community. CONCLUSIONS: VA providers described major challenges in coordinating with community providers, leading to perceptions of delayed, missed, or duplicative care and jeopardizing the overall quality, safety, and efficiency of Veteran care. Our study highlights the need for system-level solutions to support coordination across health systems for Veterans with COPD and may have implications for other conditions that lead to recurrent hospitalization and/or care in the community.

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Section: Discussionmentioning

confidence: 99%

VA Provider Perspectives on Coordinating COPD Care Across Health Systems

et al. 2019

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“…O gerenciamento na atenção primária por meio de equipes de profissionais tem se mostrado um modelo promissor de cuidado que visa identificar pacientes de risco 8 , além de auxiliar no gerenciamento de medicamentos, educação sobre medicamentos e treinamento para melhorar a adesão medicamentosa 30 . Sabese que a adesão a medicamentos é um importante aspecto para eficácia do tratamento, custos de saúde e segurança do paciente 8,31 , também traduz a noção de concordância, ou seja, um processo de tomada de decisão compartilhada entre pacientes e profissionais de saúde.…”

Section: Monitoramento Avançado De Enfermagem Na Atenção Primáriaunclassified

Monitoramento avançado de enfermagem: pacientes de risco na atenção primária

et al. 2022

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Resumo Objetivo avaliar o efeito do monitoramento de enfermagem avançado em relação ao usual para identificação do risco cardiovascular e renal, adesão medicamentosa e prática de exercícios na atenção primária à saúde. Método estudo quantitativo, quase-experimental desenvolvido na Atenção primária. Em relação a intervenção, foram consultas de enfermagem trimestrais de monitoramento avançado e laboratorial trimestral. Para coleta de dados, aplicou-se questionário sociodemográfico, escala Morisky e Questionário Internacional de Atividade Física. Resultados sexo feminino predominou nos dois grupos intervenção e controle (62,79% vs. 76,74%). O percentual de pacientes sem risco cardiovascular do grupo intervenção superou o grupo controle da consulta 1 para consulta 3, (0,00% - 25,58% vs. 6,98 - 2,33). Adesão medicamentosa máxima, ao longo do tempo, foi superior no grupo intervenção comparado ao grupo controle (48,8% vs. 23,3%). O risco cardiovascular dos usuários interferiu na atividade física de forma significativa no grupo intervenção e controle (p=0,0261 vs. 0,0438). Conclusões e implicações para a prática a monitorização avançada possibilitou uma melhor identificação de pacientes de risco e orientações aos pacientes hipertensos e diabéticos com risco cardiovascular e renal, o que favoreceu o monitoramento avançado e contribuiu ao autogerenciamento da prática de exercícios e adesão medicamentosa, a partir de consultas de enfermagem.

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“…11 While the VHA did not observe cost reductions, the improved outcomes came at no greater cost to the healthcare system compared to patient-centered medical homes, even after accounting for program costs. 6 The VHA Primary Care intensive management teams 14 were similar to other comprehensive case management teams described in the literature. 7,8,15 The teams included a physician lead (trained in internal medicine), social workers, nurses, psychologist, and in some instances, a peer support specialist.…”

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confidence: 94%